E-drug: Pharmacy practice in developing countries
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Dear friends,
I am a pharmacist working in a developing country and we have
serious drug use problems here. Earlier, I wrote about public and
private drug supply to the population of developing countries.
Today, I would like to take a broader look and discuss a number of
points that I believe are important. Development of cadres will be
the focus of them.
More specifically, I will discuss
� Regulatory authorities and the agencies licensing pharmacy
practice
� Systems for reporting complaints about ineffective drugs and
other reactions
� Analysis of pharmaceuticals in the laboratory
� Programmes to re-train staff in all pharmacies and drug shops
� What to do with the very few pharmacists in a country
� Schools of pharmacy and how to better quality of output
� Input from the general public when developing drug policies
1. Governments should budget for Regulatory Authorities and
Agencies Licensing Pharmacy Practice. Donors may assist, but
governments should consider that to be extremely relevant for
operations of their Ministries of Health. If pharmaceuticals and
related raw materials are taxed, to get money to finance activities:
it is equivalent to taxing sick people when they use drugs. Donors
may assist, but governments should consider financing regulatory
authorities and agencies that license pharmacy practice.
2. Reporting systems must be in place, for all drugs suspected to be
ineffective. The report format must be specially designed. Drug
information units should summarise those complaints and forward
findings to the Regulatory Authority for further action and
follow-up. We afford generics (not pioneer brands), so a good
laboratory analysis can not make us assume efficacy.
3. The laboratory must be able to: Assess physical-visual quality of
dose forms; identify and assay drug content of dose forms; assay
and identify impurities common in pharmaceuticals; perform tests to
prove that the generics are contain same amount of drug as the
original brands. Laboratory tests like those require equipment and
competent personnel. If the laboratory is many miles away, a lot of
problems and delays can arise. Any Regulatory Agency, therefore,
must possess or access a pharmaceutical quality control laboratory.
It should be top priority.
4. A programme to re-train nurses, midwives and medical staff
operating pharmacies on a daily basis must be launched. The
modules of the training should focus on key aspects of pharmacy
practice in respective countries. Pharmacists in practice should be
consulted about the content of the modules. We know that
face-to-face seminars do change practice. If you have a school of
pharmacy in your country, scholars there must be able to tone
material for staff operating pharmacies. And before your
Pharmaceutical Council Licenses Pharmacy Practice, there should be
need to prove that staff went through the programme.
5. Note that the few pharmacists you have should be kept at
supervisory level, because we can not afford to have few
pharmacies. People need drugs, which should be safe and effective
with adequately controlled wholesale and retail supply and use
pattern. Expand and have space for pharmacists at appropriate
levels of policy making. I have heard, with disbelief, some experts
say: "Use existing organs to reduce expenditure." True with some
activities. However, you can never substitute professionals absent
from the system. If you are to better pharmacy practice, have
pharmacists in the health system at policy and decision making
level.
6. If your pharmacists do not meet your expectations, it will be
cost-effective to train them appropriately. Alternatively, hire
expatriates to work with them, to enable them develop skill and
positive attitude.
7. Schools of pharmacy must expand intake and emphasis should
be on challenging subjects like - clinical pharmacy, pharmaceutics
(with practical orientation in development, design and analysis of
pharmaceuticals). For countries where animals contribute to the
economy, veterinary Pharmaceuticals contribute to a better animal
health. Have lectures in veterinary pharmacy. Have experienced
colleagues or visiting lecturers from more developed schools of
pharmacy.
8. Explain and interpret legislation governing drugs to the general
public, and explain how such law protects them - if it does.
Certainly, there will be in-put. For example: Will your nationals
allow tax on drugs? Will your nationals allow a passive look as
inferior generics infiltrate their country? Won't your parliament arise
to the need for the government to invest in generic manufacturing?
9. Those holding diplomas in pharmacy should directly supervise
Class C drug shops or units. Expanding the list of drugs for their
custody is risky, in a profit motivated private sector. They will in
effect operate mini pharmacies, without appropriate training.
10. Drug and Therapeutics Committees (DTCs) must be at all levels
of decision making, which govern drug selection, control
distribution and use. In fact, a Drug Regulatory Authority is like a
national "Drugs and Therapeutics Committee." DTCs discuss and
implement drug use issues in given settings: country level, district
level and hospital or health facility level. If one person or an
inappropriate group makes decisions about a vital subject like drug
use, we are bound to continue with unnecessary expenditure and
inferior generics -- with public murmurs.
11. Public Drug-Use education is as important as campaigns arguing
people to build toilets and wash hands with soap and water after
toilet. Public drug use education must be budgeted for and done
under the Information, Education and Communication Departments
of Ministries of Health. Pharmacists (or drug information units) best
do it, in collaboration with experts in Information Education and
Communication.
Sincerely,
George Kibumba, MPS
Community and Drug Information Pharmacist, Uganda
e-mail: did.jms@imul.com
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